Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My Public Portal
About
Bryan Pest Control Services Contract
JUN/19/2014/THU 02:22 PM FAX No, 850 e 5508 P, 002 PEST CONTROL 911 Don Drive Ft Walton Beach, FL 32547 350.862.3955 Fax:850,864.2815 June 19, 2014 City of Crestview Department of public Services Dear Sirs, 604 Elm Street Niceville, FL 32578 850.678.5508 5454 Gulf Breeze Parkway Gulf Breeze, FL 32563 850.916.1124 Crestview: 850.682.5553 Destin. 850.837.5137 Pensacola! 850,969,9147 After considering the content of the meeting with Carlos Jones on June 18, 2014 in reference to the pest control bid for the City of Crestview, we offer the .following: • We propose to you quarterly guaranteed service for all 15 stops at the rate of $66.00 for each stop. We would treat every three months with residual product and take care of any problems between services at no charge. At the rate of $66.00 a quarter for each building, the cost would be $990.00 per quarter, and the yearly cost would be $3,960.00. We could charge it out on a monthly basis, if you prefer, and that rate would be $330.00 per month. With environmental concerns at the forefront in today's world, consideration of this method of treatment could be in your best interest. Most of the government agencies, military groups, schools, hospitals, nursing homes and even resorts have adapted this method of treatment to reduce pesticide exposure to the environment as well as employees and citizens alike, and remember, this service is guaranteed_ Thank you for your consideration. Sincerely, Allan Quigley General Manager Bryan pest Control, Inc. Ruaaty is our standard... Excefetrcc is our goal; ..we're GREEN!" N P M W9•6191� .bryaepe®tcontrol.com INUN/19/2014/THU 02:22 PM r FAX No, 850 6`~q 5508 P, 001 Ow/lot Pest Control Serving Four Counties Okaloosa Walton Santa Rosa Escambia Phone: 850-678-5508 Fax: 850-678-3890 Fax Transmittal Form To NAME: ORGANIZATION: PHONE: FAX NUMBER: eva&d, ?Qcx,2 h-e-,-)-4 if Ail -Le., ivi,?,141_, 5D,3 49s 73 Siteat PEST CONTROL From 1.4Qu-{Gty Phone: 850-678-5508 Fax: 850-678-3890 Email; SwatTeam@BryanPestControl.com DATE: PAGES SENT: Message: Thapide rJ, ou for your busiwess! Urgent For Review Please Comment Please Reply rrt r/! SlrFlON 00500 AGRIANI;NT CITY OF CRESTVIEW, FLORIDA PEST CONTROL SERVICES CONTRACT On August I I, 2014 TIIE CITY COUNCIL OF TIIE CITY OF CRESTVIEW, FLORIDA, herein referred to as the City, accepted the bid of Bryan Pest Control, Inc. herein referred to as the Contractor, in the amount of $3,960.00 yearly cost, to supply pest control services for City properties. TERMS AND CONDITIONS OF CONTRACT FOR THE Pest Control Services Contract 1. Entire Contract: This Contract represents the entire and integrated Contract between the City and Contractor and supersedes all prior negotiations, representations or contracts, either written or oral. The Advertisement to Bids, Bid Form, Insurance Requirements, Non -collusion Affidavit, Public Entity Crimes Affidavit, Drug -Free Workplace Declaration, and Notice of Award arc included in the contract documents binding the parties. Provisions of this Contract may be amended only by written instrument approved by the Crestview City Council and signed by the Mayor and Contractor. Intent of Contract: This contract will provide pest control services for approximately fourteen (15) locations for the City of Crestview. The successful Bidder will provide all the material, chemicals, equipment, and labor necessary to facilitate quality workmanship in his performance of this project. 1.1 Statement Of Work (Pests) - The successful Bidder will perform whatever tasks are necessary to clear buildings of all pests. Pests should be defined as but not limited to: Birdsi Rodents and Insects and should include the following: roaches, ants, rats, mice, silverfish, fleas, birds, and squirrels. Grounds treatment at the locations will include lire ant protection as needed. Monthly (Quarterly) scheduled treatments will continue for the life of the contract facilitating a non -pest environment. The maintenance servicing will be accomplished so as not to interfere with the Stalls day-to-day operations. This may require servicing after normal working hours. As such, coordinating the monthly service is of utmost importance. Statement of Work (Termites) — If qualified, in a separate quotation, the successlid Bidder, upon approval, may be asked to perform whatever tasks arc necessary to clear buildings of active termite damage and put any necessary protection in place to prevent further damages for the specified buildings listed in the Bid Proposal. 1.2 Service Call Re -Visit - Should the occasion arise requiring the successful Bidder to re -visit a particular facility, off schedule, the unscheduled re -visit will not be cause for additional charges. 3. Term of Contract and Time Extensions: This contract will be in effect from September I, 2014 through September 30, 2017. 3.1 Base Year - The base year of this contract, if awarded, will commence upon the receipt of Purchase Order and continue through September 30, 2014. 3.2 First Option Year - The calendar period commencing on October 1, 2014 thru September 30, 2015. 3.3 Second Option Year - The calendar period commencing on October I. 2015 thru September 30, 2016. Pest Control Services 00500-1 022714 3.4 'Third Option Year - The calendar period commencing on October I , 2016 thru September 30, 2017. 4. Compensation: All payments upon contract are contingent upon the Contractor's Work being acceptable to the City. For satisfactory completion and acceptance of the Work, the City agrees to pay the Contractor in accordance with the terms of this Contract. 5. Insurance: Contractor shall, during the performance of the contract, maintain Worker's Compensation Insurance sufficient to secure benefits of the Florida Workmen's Compensation Law I'or all employees and any of the work sublet to any vendor or subcontractor, Comprehensive General Liability Insurance, and Auto Liability Insurance, all with companies and in the form and amounts acceptable to the City. If any part of the work is sublet, similar insurance shall be provided by and in behalf of any subcontractors. Evidence of Insurance: Contractor shall provide the City Certificates of Insurance naming the City as an additional insured and certificate holder. All binders, policies, or certificates of insurance shall provide for at least ten days' notice from insurers to the City orally cancellation or amendment to any of the insurance policies. 6. Indemnification: Contractor shall indemnify, defend, save, and hold the City, its agents, officers and employees, harmless of and from any losses, fines, penalties, costs, damages, claims, demands, suits, and liabilities of any nature, including reasonable attorney's fees (including regulatory and appellate fees), arising out of, because of, or due to any accidents arising in any manner on account of the exercise or attempted exercise of Contractor's rights hereunder whether the same regards person or property of any nature whatsoever, regardless of the apportionment of negligence, unless due to the sole negligence of the City. Contractor shall indemnify, defend, save and hold the City, its agents, officers and employees, harmless of and from and against any and all liens, claitns, damages, demands, suits and liabilities, attorney's fees and costs, including appellate attorney's fees and costs, of and for mechanics and material men litrnishing labor and materials in the perlimnance of this contract. 7. Licensing: 'Ihe Contractor shall obtain all permits and maintain at its expense all professional and business certificates and licenses required by the City or otherwise by law and as necessary to perform services under this Contract. II' Contractor performs any Work without obtaining, or contrary to, permits and licenses, Contractor shall bear all costs arising there from. 8. Cancellation: This contract may be canceled by either party with a sixty day written notice and is contingent upon the annual appropriation by the City of legally available funds. City's obligation to pay the amount due hereunder in any fiscal year is contingent upon the appropriation by the City Council of legally available funds for the purposes set forth in this contract. 9. Performance of WorlJResponsibilities: The Contractor shall commence work in a reasonable length of time and shall complete the work in an expeditious manner. In emergency' situations, the Contractor shall endeavor to commence work immediately. All work shall be done under the supervision of the City's Public Service Director or designated representative. The performance of Work and responsibilities hereto are outlined and made a part hereof as identified in "Description of Work". Pest Control Services 00500-2 022714 10. 'Termination for Default: The Contract will remain in force for the full period specified and until the City's Public Services Director or his designee determines that all requirements and conditions have been satisfactorily met. However, the City Public Services Director will have the right to terminate this Contract sooner if the Contractor has failed to perform satisfactorily the work required or comply with the other requirements of the Contract. In the event the City Public Services Director decides to terminate this Contract for the Contractor's failure to perform satisfactorily or meet its other responsibilities under the Contract, the City Public Services Director will give the Contractor five (5) days' notice, whereupon the Contract will terminate, unless during the notice period the Contractor cures the failure to perfonn or meets its other responsibilities under the Contract to the satisfaction of the City Public Services Director. Upon Contract termination for the Contractors failure to provide satisfactory contract performance, the Contractor will be entitled to receive compensation for Contract services satisfactorily perl'onned by the Contractor and allocable to the Contract and accepted by the City Public Services Director or his designee prior to such termination. I lowever, an amount equal to all additional costs required to be expended by the City to complete the Work covered by the Contract. including costs of delay in completing the project, shall be either subtracted from any amount due or amount charged to the Contractor in the event the City Public Services Director terminates the Contract. Except as otherwise directed by the City Public Services Director, or in the case of termination for default (in which event the Contractor may be entitled to cure, at the option of the City Public Services Director), the Contractor shall stop work on the date of receipt of the notice or other date specified in the notice, place no further orders or subcontract for materials, services, or facilities except as are necessary for the completion of such portion of the work not terminated, and terminate all contractor and subcontracts and settle all outstanding liabilities and claims. In the event that any termination jOr default shall he found to he improper or invalid by any court of competent jurisdiction. then such termination shall he deemed to have been a termination fur convenience. l I. 'Termination for Convenience: The performance of work under this Contract may be tenninated by the City Public Services Director in whole or in part whenever the City Public Services Director, in his discretion, determines that such termination is in the City's best interest. Any such termination shall be effected by the City l'ublic Services Director giving at least five (5) days' notice to the Contractor, specifying the extent to which performance of the work under this Contract is terminated and the date upon which such termination becomes effective. As to termination for convenience, after receipt of the date of termination, the Contractor shall stop all work as specified in the notice; place no further orders or subcontract for materials. services, or facilities except as are necessary for the completion of such portion of the Work not terminated; and terminate all contractors and subcontracts and settle all outstanding liabilities and claims. 12. Disclosure: Contractor warrants that it has not employed or retained any company or person, other than a bona fide employee working solely for the Contractor to solicit or secure this Contract and that it has not paid or agreed to pay any person, company, corporation, individual, or firm, other than a bona tide employee working solely for the Contactor, any tee, commission, percentage, gift, or other consideration contingent upon or resulting from the award or making of this Contract. 13. 141 iscellancous: Pest Control Services 00500-3 022714 13.1 Governing Law The parties intend that this Contract and the relationship of the parties shall be governed by the laws of the State of Florida. Venue for any action arising out of this contract shall be in Okaloosa County Florida and nowhere else. 13.2 Scverability If any section, subsection, term or provision of this Contract or the application thereof to any party or circumstance shall, to any extent, be invalid or unenforceable, the remainder of said section, subsection, term or provision of this Contract or the application of same to parties or circumstances other than those to which it was held invalid or unenforceable, shall not be affected thereby and each remaining section, subsection, teen or provision of this Contract shall be valid or enforceable to the fullest extent permitted by law. 13.3 Sovereign Immunity The parties further agree, nothing contained herein is intended nor shall be construed to waiver the City of Crestview's rights and immunities under the Florida constitution, common law or Florida Statutes 768?8, as amended from time to time. 13.4 Construction The Parties have participated ,jointly in the negotiation and drafting of this Contract. In the event an ambiguity or question of intent or interpretation arises, this Contract shall be construed as if drafted jointly by the Parties and no presumption or burden of proof shall arise favoring or disfavoring any Party by virtue of the authorship of any of the provision (Willis contract. 13.5 Attorney's Fees In any dispute relating to this contract each party shall be responsible for their respective attorney's Ices and costs. 13.6 Notices All notices under the Contract shall be in writing and shall be effective when mailed by certified mail, return receipt requested, or when delivered personally, as provided hereafter, or to such other addresses as may be designated by notice: 13.7 Public Records: Contractor shall comply with Florida Public Records Law, specifically to: (a) Keep and maintain public records that ordinarily and necessarily would be required by the City of Crestview in order to perform the service. (b) Provide the public with access to public records on the same terms and conditions that the City of Crestview would provide the records and at a cost that does not exceed the cost provided in Chapter 119, Florida Statutes or as otherwise provided by law. (c) Ensure that public records that are exempt or confidential and exempt from public records disclosure requirements are not disclosed except as authorized by law. (d) Meet all requirements for retaining public records and transfer, at no cost, to the City of Crestview all public records in possession of the contractor upon termination of the contract and destroy any duplicate public records that are exempt or confidential and exempt from public records disclosure requirements. All records stored electronically must be provided to the City of Crestview in a format that is compatible with the information technology systems of the City of Crestview." Pest Control Services O0500-4 022714 As to the City: City of Crestview As to the Contractor Bryn Pest Control, Inc. Sign:/ �vG IN WITNESS WHEREOF, the City hereunto caused these pr sents to be subscribed and the Contractor has affixed their name and seal, this ; 7 day of f wS , 2014. ATIT-Si : Elizatfeth Roy, City Clerk ) AS TO LEGAL ORM: ` By: David Cadle Mayor END OF SECTION State of FIAK,I PR _ thefgre9o�^9495V twAsackrrowled9edt� Pe ^aM eP� before me and acknovnedged 1Lb7 lea the osaanent vaemtan• M ra the purpose expte *ewe el Navy ti+Mc i� � Notary Public State of Florida John K Evans � r My Commission EE017291 1'ta note Expires 10/11/2014 Pest Control Services 00500-5 022714 SF.C.I'ION 00300 1111)10hill S111311111'I I D: r ~_ l -5 - f cfC Date I'ROJR1 IDENT'IHCATION: CITY OP CRES'fVIEN1' I'EST CONTROL SERVICES NAn11 OF BIDDLR: /5f'.yIY/L) /7, 57 - C==�/t-1 %i�'� �._ f /1-/C . BIISINI:SS ADINWSS: cJ 1/" L. l i.97 -S77'L7f � �L:ci�j�Ll� f f`/__ : �'� 17,-7g Phone No.: 1{-Mail Address: /T U/11_ FLORIDA 1_IC FNSE NO.: •3-6 z e/. / ax No.:1 THIS 1311) IS S(. BNIFt"IT.1) TO: City of Crestview, Florida (hereinafter called Owner) acting through its City Commission. I. the undersigned Bidder offers and agrees to enter into an Agreement \kith Ohtiucr in the firm included in the Bidding 1ocuments, to complete all kvorl: for the ('ontract Price and within the Contract Time, all in accordance with the Contract Documents. 3. Bidder accepts all of the terms and conditions of the (Inkling Documents, inclndin, without limitation those dealing with the Owner's time for accepting for laid and the disposition of laid Bond. 3. In submitting this Bid, Bidder stakes all representations required by the Instructions to Bidders and further warrants and represents that: (a) Bidder has examined copies of all the Bidding Documents and of the tbilowimg addenda: No. I)ated No. Dated No. Dated •No. - - Dated (Receipt of all which is hereby acknowledged) and also copies of the Advertisement lur Bids and the Instructions to Bidders. (b) Bidder has examined the site and locality krhee the 'Work is to be performed and the legal requirements (Federal, State and local lags, ordinances, rules and regulations) and conditions affecting, cost, dc! ree of difficulty, progress or performance of the \l'ork and has made such independent investigations as Bidder dents necessary. (c) This Bid is genuine and not made in the interest or on behalf of any undisclosed person, lint or corporation and is not submitted in conformity with any agreement or rules of any group, association, organiration or corporation; Bidder has not ITS l ('ONI IZOI. SFRVIC'FS 0030 ►-1 022714 directly. or indirectly induced or solicited any other Bidder to submit a false or sham Bid; Bidder has not solicited or induced any person, tire► or a corporation to refrain from bidding,; and Bidder has not sought by collusion to obtain fin. himself any advantage over any other Bidder or over Owner. (d) Bidder hereby agrees if this Bid is accepted, to commence wort: under this ccn►tract on or belbre a date to be specified in the Notice to Proceed and to hilly complete all work of the Project within the Contract Time. 1. 13ictder submits to perform all the Work as required by the scope of work fi►r the City of Crestview. 13id shall be awarded to the lowest responsible bidder. �. All Bids shall include all materials, equipment, labor, permit fees, taxes, tests, miscellaneous cost; of all types, overhead, and profit for the item to be complete as stated in the instructions to bidders. 1311) PROPOSAL, PIZO.IFC : 1'h,S1' ('UNT12()1, SLItVit'LS for the City of Crestview, Florida The 13idder proposes (to furnish all labor, materials, equipment and suppli(..$) to pertOrm all \fork for the titllowin!g price: Item No. Description Quarterly Yearly 1 C'ouncil on Ageing 198 S. 11'ilson Street 66.00 2 City I kill 198 N. Wilson Street 66.00 Public Services Complex (includes 4 Buildings) / 15 N. Ferdon Blvd 66.00 4 George 11. Whitehurst Building 201 Stillwell Blvd. 66.00 5 Dire Station tit 321 W. Woodruff 66.00 6 Fire Station tit 2106 P. J. Adams Parkway 66.00 7 Fire Station t13 555 13rookmeade Drive 66,00 S Environmental Center Butler Circle 66.00 Twin Hills Park Complex (includes 5 buildings) 100 S. Hathaway 66.00 10 Community Center 1446 Commerce Drive 66.00 11 OST Park & Senior Center ( Includes 3 Buildings) 205 Stillwell GG.t)0 12 Fairview Itecreation Center (Includes 2 Buildings) 649 N e('lelland (i6A(! 13 911 call Center 21061'. 1. Adams Parkway 66.00 14 City library 14-15 Commerce Drive 66.00 15 C'ountryViewy Park 1090 N'orthview Part. Drive 66.00 Total Bid $ 3,960.00, PI 'Si C't)NTIt(11. SI It4'IC'LS 00 u►t►_ 1 r►?)7I t '101 Al, l3ASli lilt): (Numeral s)S3,960.00 ( Written) /���� i, % cr -0 Provide; pricing, for all required labor, materials, equipment and supplies to complete all the work indicated for the city as indicated in these. specifications. If there is a difference between the numerical or written values. the written will take precedence or whichever is in the hest interest ofthe City of Crestview. Florida. /�/ )(42/0 6. Print Name of Contractor R pres ntatiCc ofCon actoe Signature 7 __ none 1)ate The following documents are attached to and mach it condition or this laid: Advertisement fin• bids (Section 00020). Drug Free \Vorl:place (Section 310). Public Entities Crime Form (Section 00470). Noncollusion Affidavit (Section 00480). Instructions to Bidders (Section 00100). Insurance requirements (Section 00650). Questionnaire (Section 00301). References (Section 00302). Similar (:mitracts (003030. END OE SEC IION ITSI('UN 1 I:01. SI�:I:VICLS 00300-3 State off+ The..a14oregone nsttru�4 uYacknpyerd thm_a_day d MIL' �`�+� who personally appeared before me and acknowleflgBLr'ttit h sgned the nstrunent eohrmari• y for the purpose a §wature or nblerr Pebet Arra rpw otter crMnwron•d A nwd Nary Pok Notary Public State of Florida John K Evans My Commission EE017291 Expires 10/11/2014 U? , 71-1 EQUAL OPPORTUNITY CLAUSE/EXHIBIT A During the performance of this Contract, the CONTRACTOR agrees as follows: 1. The CONTRACTOR will not discriminate against any employee or applicant for employment because of race, color, religion, sex, or national origin. The CONTRACTOR will take affirmative action to ensure that applicants are employed, and that employees are treated during employment, without regard to their race, color, religion, sex, or national origin. Such action shall include, but not be limited to the following: employment, upgrading, demotion, or transfer, recruitment or recruitment advertising; layoff or termination; rates of pay or other forms of compensation; and selection for training, including apprenticeship. The CONTRACTOR agrees to post in conspicuous places, available to employees and applicants for employment, notice to be provided by the contracting officer setting forth the provisions of this non-discrimination clause. 2. The CONTRACTOR will in all solicitations or advertisements for employees placed by or on behalf of the CONTRACTOR, state that all qualified applicants will receive consideration for employment without regard to race, religion, sex, or national origin. 3. The CONTRACTOR will send to each labor union or representative of workers with which he has a collective bargaining agreement or other contract or understanding, a notice advising the labor union or workers' representative of the CONTRACTOR's commitments under Section 202 of Executive Order 11246 of September 24, 1965, and shall post copies of the notice in conspicuous places available to employees and applicants for employment. 4. In the event of the CONTRACTOR's non-compliance with the non-discrimination clauses of this contract or with any of such rules, regulations, or orders, this Contract may be canceled, terminated or suspended in whole or in part and the Contractor may be declared ineligible for further contracts with the CITY OF CRESTVIEW, FLORIDA. Provided, however, that no such action shall be taken without prior notice to the CONTRACTOR and an opportunity for a hearing before the CITY ATTORNEY or its designee. 5. The CONTRACTOR will include the provisions of paragraphs (1) through (5) in every subcontract or purchase order for an amount exceeding Ten Thousand Dollars ($10,000), or which can reasonably be expected to have an aggregate total value exceeding Ten Thousand Dollars ($10,000) in any twelve (12) month period, so that such provisions will be binding upon each subcontractor or vendor. Date g-- 02 stete of j-Lera's13. 9t_�n91014 w aCknp pledged thisi,Zoay of .4606, before nip and ackno F�S6 j who personally appeared �y�� h' Knee the Tshument vokmtan- y for the purpose ez. ����� &water, of Notary Pobk �(� 'mPL`• �... meo ;p John K Evans c. My Comrniasion EEo17291 �M1o,F Expires 10/11/2014 Sign/� /4��� (Cont actor) Print/Type X°'//% ��� (Project) -1- CERTIFICATION OF NON -SEGREGATED FACILITIES/EXHIBIT B By entering into this Contract, the CONTRACTOR certifies that he does not maintain or provide for his employees any segregated facilities at any of his establishments, and that he does not permit his employees to perform their services at any location under this control, where segregated facilities are maintained. He certifies further that he will not maintain or provide for his employees any segregated facilities at any of his establishments, and that he will not permit his employees to perform their services at any location, under his control, where segregated facilities are maintained. The CONTRACTOR agrees that a breach of this Certification is a violation of the Equal Opportunity Clause in this Contract. As used in this Certification, the term "segregated facilities" means any waiting rooms, work areas, rest rooms and wash rooms, restaurants and other eating areas, time clocks, locker rooms and other storage or dressing areas, parking lots, drinking fountains, recreation or entertainment areas, transportation, and housing facilities provided for employees which are segregated by explicit directive or are in fact segregated on the basis of race, color, religion or national origin, because of habit, local custom, or otherwise. He further agrees that (except where he has obtained identical certifications from proposed subcontractors for specific time periods), he will obtain identical subcontractors or purchase orders exceeding $10,000: that he will retain such certifications in his files and make them available to the CITY OF CRESTVIEW upon request. Provided, however, that such certification shall not be required in the case of purchase orders or contracts which, in case of a Federal Government contract or subcontract, would be exempt from compliance with the Equal Opportunity Clause by 41 CFR Sec. 60-1.5. This Section provides for the exemption of transactions not exceeding $10,000, contracts and subcontracts for indefinite quantities estimated not to exceed $10,000 in any contract year, contracts with certain educational institutions, work on or near Indian reservations, facilities (including, but not limited to, agencies, instrumentalities or subdivisions of state or local government) which are separate and distinct from activities of the prime contractor or subcontractor emergencies involving national security. Date < 7-/V State or t►24 Thefyregby instrument a cknpwl�dgedtwh�„�_oalhi `6, �$t l�-ttlTj persona�ry appeared before me and acknowk,.: -fined the mstrument voluntari- y for the purpose ezp '?� aii Sgnalure of M,tar,. P A4c gar Pt*, Notary Public State of Florida John K Evans o` My Commission EE017291 aM1ott. Expires 10/11/2014 Sign 1 (Contractor) 0r/l7 Zr.,/67 Print/Type (Project) -1- a DRUG -FREE WORKPLACE/EXHIBIT C The ersigne ontractor in a cordance with Florida Statute 287.087 hereby certifies that k 44-t e,17/ <-7 e - does: (Contractor) 1 Publish a statement notifying employees that the unlawful manufacture, distribution, dispensing, possession, or use of a controlled substance is prohibited in the workplace and specifying the actions that will be taken against employees for violations of such prohibition. 2. Inform employees about the dangers of drug abuse in the workplace, the business's policy of maintaining a drug -free workplace, any available drug counseling, rehabilitation, and employee assistance programs, and the penalties that may be imposed upon employees for drug abuse violations. 3. Give each employee engaged in providing the commodities or contractual services that are under bid a copy of the statement specified in subsection (1). 4. In the statement specified in subsection (1), notify the employees that, as a condition of working on the commodities or contractual services that are under bid, the employee will abide by the terms of the statement and will notify the employer of any conviction of, or plea of guilty or nolo contendere to, any violation of Chapter 1893 or of any controlled substance law of the United States or any state, for a violation occurring in the workplace no later that five (5) days after such conviction. 5. Impose a sanction on, or require the satisfactory participation in a drug abuse assistance or rehabilitation program if such is available in the employee's community, by any employee who is so convicted. 6. Make a good faith effort to continue to maintain a drug -free workplace through implementation of this section. As the person authorized to sign the statement, I certify that this firm complies fully with the above requirements. Date 'f 'z 7 - State of 4t » egegomg�RrMt aSyCknO�cleOgedtMs�oaYdAk, {�. by Rr k:tL-F7lY whe personally appeared before me and acknowlen 9U the instrument voluntari- ly for the purpose Pap: Spnature or NntaryPubes Aratt. hoe of cramp Commas mad Nome of Notary Pueac Notary Public State of Florida John K Evans A My Commission EE017291 Expires 10/11/2014 Sigq (Contrac or) Print/Type / /// (Project) -1- " S r ( ' S W O I : N S I A l I N I L : N - I I ' U I t S t 1 A N I ' T O S E ( ' I I O N 2 8 7 . 1 3 3 ( 3 ) ( a ) , 1 1 , 0 I : I I ) A S " I A T I F I L S , O 1 ' . ' 1 ' 1 1 1 3 1 . 1 ( ' E N I I T V C ' R I \ I 1 S ( I 1 1 S F O R M t v I U S T 1 3 E S I G N L I ) A N D S W O I : N T O I N T I I L ; P R E S H N C F , O F A N ( Y f A I : 1 ' 1 ' 1 1 1 1 1 . 1 C O l t ( T 1 1 1 1 : O F F I C I A L A U 1 1 1 O 1 : 1 Z 1 1 ) T O A D N I I N I S I L I : O A T H S . 1 . T h i s s c o r n s t a t e m e n t i s s u b m i t t e d t o C i t y o f C r e s t v i e w 3 . ( p r i n t m a l e o f t h e p u b l i c e n t i t y ) b y B i l l y R i l e y , B r a n c h M a n a g e r ( p r i n t i n d i v i d u a l ' S n a m e a n d t i t l e ) f o r B r y a n P e s t C o n t r o l , I n c . ( p r i n t m a t e " O f e n t i t y s u b m i t t i n g s w o r n s t a t e m e n t ) t 1 1 R . e b u s i n e s s a d d r e s s i s 6 0 4 E l m S t r e e t . N i c e v i l l e , F I : 3 2 5 7 8 a n d t i f a p p l i c a b l O i t s F e d e r a l F i n p l o y e r I d e n t i f i c a t i o n N u m b e r ( 1 1 . 1 N ) i s 5 9 7 1 . 7 . 1 9 7 7 ( I I ' d i e t a u t . h a s n o I L I N . i n c l u t c t h e S o c i a l S e c u r i t y N u m b e r o f t h e i n d i v i d u a l s i g n i n g t h i s s w o r n s t a t e m e n t : _ . _ _ , 1 I u n d e r s t a n d t h a t a " p u b l i c e n t i t y c r i m e " a s d e f i n e d i n P a r a g r a p h 2 1 ; 7 . 1 3 3 ( I ) ( t ; ) , F l o r i d a S t a t u l e S . m e a n s a N ' i o t a l i o n o f a n d s t a t e o r f e d e r a l l a ` , b y a p e r s o n w i t h r e s p e c t t o a n d d i r e c t l y r e l a t e d t o t h e t r a n s a c t i o n o f b u s i n e s s w i t h a n y p u b l i c e n t i t y o r w i t h a n a g e n c y o r p o l i t i c a l s u b d i v i s i o n o f a n y o t h e r s t a t e o r o f t h e U n i t e d S t a t e s . i n c l u d i n g , b u t n o t l i m i t e d t o , a n t h i d o r c o n t r a c t f a r f o o d . : o r s e r v i c e s t o p r o v i d e d t o a n y � p u b l i c e n t i t y o r o n a g e n c y o r p o l i t i c a l s u b d i v i s i o n o f a n y o t h e r s t a t e o r o f t h e l i n k e d S t a l e s a n d i n v o l v i n t ! a n t i t r u s t , f r a u d , t h e f t , b r i b e r y , c o l l u s i o n , r a c L e l e e r i n g , c o n s p i r a c y , o r m a t e r i a l m i s r e p r e s e n t a t i o n , I u n t k r ; s t a n d t h a t " c o n v i c t e d ' o r - c o n v i c t i o n . ' a s d e f i n e d i n P a r a . t r a p h 2 8 7 . 1 3 3 ( 1 ) ( 1 9 , F l o r i d a S l a l t r t e s m e a n s a f i n d i n g o f g i u i l t o r a c o n v i c t i o n o l ' a p u h t i c e n t i t y c r i m e . i t h o r t i i t h o u t a n a d j u d i c a t i o n o f i n a n y f e d e r a l o r s t a t e t r i a l c o u r t o f f e e t �%r d r e l a t i n g t o c h a r g e s b r o t t . d i t i n d i c t t t �%c n t o r i n l O r m a t i o n a f t e r . l u l l " I . 1 9 8 ( ) , a s a r e s u l t o f a j u t v e r d i c t , I �%o n j u r N t r i a l , o r c " n t n " ( ) f a p l e a o f g u i l t y o r n o b �% c o n t e n d e r e , I t i n t ; r s t a n d t h a t a n ` a l l i l i a t e " a ; d e l i n e c l i n P a r a g r a p h 2 S 7 . 1 3 3 ( I ) ( a ) . F l o r i d a S t a t u t e s . m e a n ; : 1 ' e ; 1 ( ' o n U ��, l S e r v i , e s 0 0 1 7 0 - 1 0 : ) . - 2 7 1 , 1 I. A predecessor or successor of a person convicted of public entity crime; or �. An entity under the control of any natural person who is active in the management of the entity and who has been convicted or a public entity crime. The term "affiliate" includes those officers, directors, executives. partners, shareholders, employees, members, and agents who are active in the management of an affiliate. "rhe ownership lw one person of shares constituting a controlling interest in another person, or a pooling of equipment or income among persons when not for lair market value under an arm's length agreement, shall be a prima facie case that one person controls another person. A person who Imowingly enters into a joint venture with a person who has been convicted ol' a public entity crime in Florida during the preceding 36 months shall be considered an affiliate. ;. I understand that a -person- as defined in Paragraph 287.133(1)(e). Florida Statutes. means any natural person or entity organized under the laws of any state or of the United States with the Ier�,a1 power to enter into a binding contract and which bids or applies to bid on contact; for the provision of goods or services let by a public entity, or which otherwise transacts or a1plies to transact business with a public entity. The term "person - includes those officers, directors. executives, partners. shareholders, employees. members, and ailenls who are active In management of an entity. b. partied on inhumation and 1)clicf. the statement ovltieh 1 have marked belov is true it relation li► the entity submitting this ssu►rn statement. (indicate v,hir( statenhan applies.) X Neither the enlity submitting this sworn statement. nor any of its officers, directors, executives. partners. shareholders, employees. members, or agents who are aetive in the ntana,rentent of the entity, nor any affiliate of the entity has been charged v,.ith and convicted ()fa public entity crime subsequent to loly 1, 1989. X The entity submitting, this s‘orn statement. or one or more of its officers, directors. executi%es. partners. shareholders, employees, members. or a<,ents who are active in the nuutatientent of the entity. or an affiliate of the entity has been charged with and convicted of public entity crime subsequent to►.luly I, 1989. . X_.. .111c cntil) submitting this sworn statement. or one or more or its oflicers. directors. executives. partners. shareholders, employees, member;. or agents \vhu are active in the management (ripe entity, or an affiliate of the entity has been charged with and convicted of a public entity crime subsequent to July t, 1989. I towever, there ha'. been a subsequent proceeding before a I [caring ()nicer of the State of Florida, Division of Administrative Hearings and the Final Order entered by the Hearing Officer determined that it was not in the public interest to place the entity submitting this soy-orn stctement on the con%icted vendor list. (attach a copy or the final order.) Ire>I ('outol tierviees 00170-2 022714 HANDERS 1 AND I I IA1 T111. S1113ti11SSION OE 1111S FORM 'fO I I I1, CON 1 I:AC I ING 01:110ER 1 OR THE l'11131,1(' EN ITIN 11)ENTIFIED IN PARAGRAPH I (ONE) ABOVE IS 1:012 TI I,1 I Ming(' E 111 Y ONLY AND, "MAT 1 I IIS 1:01M1 IS VALID TI IRO11(11 1)EC1'NIIIEIZ 31 01 THE CALENDAR YEAIZ IN WHICH IT IS FILED. I ALS() 1INDERSTANI) TI1AT I A1\1 1tEQI.IIRI;U TO INFOI,r1 THE PUMA' ENTITY ITY I'ItIOR TO ENTERING INTO A ('ONI1VAC1 IN EXCESS OF THE `I IIRESIIOI,I) A1\1O11NI' PROVIDED IN SECTION 287.017, 1:1,OKII)A STATUTES EOR, (.'AT GOI:Y 111'0 OF ANY CI IANGE IN 111E, INFOItMA'I R)N CONTAIN;I) IN 'I'l IIS, FORM. Sworn to and sitbseribed before me this Personally I.nm,.n E f tC�Y -1 ( 1I, Produced izicntification pc of identillc.ition) c-.r.rtirvvn.V.�v^v`�.�vr 00 N I'e>t CIInt1.11 Votary Pu24r Slave: cV Floraa JONI K [vans 61 y C(MriMiS51102 EV)1 /D I Erpitas 1^w1 it J14 siunature) Notary Public - State 111 ,1% zlttlI k ,)) cNpires Florida jltiut .d,-(yy l or siampcd commissionm amo or'minty public.) END ()I' SECTION (tit 170 022 I I4 SECTION 0(18(1 NONC 1,1,l ISION Arrll)AVI I STA] E Or Florida couN rY or okaloosa Billy Riley being first duly s\% one deposes and says that: (. fie (it) is the Branch Manager . of' Rr.yan Pest Control , Inc. , the Bidder that has submitted the attached Bid; ?. Ile is Dull} informed respecting the preparation and contents of the anached Rid and of all pertinent circumstances respecting such laid; ;. Stich Bid is genuine and is not a collusive or sham Ilid: Neither the said flidder nor any of its of ricers. partner;. owners. agents, representatives. employers, or parties in interest, including this affidavit. have in any way, colluded, conspircd, connived 4.,r a-!reccl. directly or indircctls, with any c►tlrer Bidder, lien or person to submit a collusive or sham Bid in connection with the Contract for which the attached Bid has been submitted; or to refrain from bidding in connection with such Contract: or have in any manner, directly or indirectly. sottOt by agreement or collusion, or communication, or conference with any Bidder, first. or Nrstm to fix the price c►r prices in the attached Bid or of any other Bidder, or to lix any overheaa, profit, or co:it clement: o,l' the kid price or tite Bid price of any ()titer ilidder. or to secure through any collusion. conspiracy, connivance. or unlawful agreement any advantage against (I:ecipient). or any person interested in the propose::I Contract; I he price or prices quoted in the attached Bid are fair anal proper and are not minted b any collusion, conspiracy, connivance, or unla:v ful agreement on the paint of the I lidder or any other of its agents, rcpwsentatives, O,vners, employees or parties; in interest, including this affidavit. Pratt°o�nh�ol Seniors 00180-1 (0.171 I it., 1), i t,14 (). I 1.(-7 sworn and subscribed in bel'ore n1c !Ids 7.1174.:, (lay (u' State or Viir.:V . County or ()k".M.f.1;$7„t, Lxpire_ lYst Control StTvicos Notary Public o' °v., Notary Public: State Floods /: John K Evans --My Catturisstan EE017291 error Evivtel 10/11(2014 IND OF SI4' I ION / 4 in the 180.-:). ser11.1 " �� W g r , r , " 3 1 1 C ? " �� 4 . p s i / / / 7 " 1 1 t i T t 2 2 a 1 - 2 : ? 7 / 7 / 7 . A \ 1 1 P M - , 2 7 ! / / J n \ 1 1 A 7 s = ] ��1 7 1 ! / i A w y 1 ' : 1 7 1 t ' I A T E O r F L �%R I O % I ! D t p a r t n l r o t o f f c l Q r ( n d t u r r n u b C O I 1 S 1 1 1 1 1 r 1 ' ' , e r b i c r s 1 m i t r n r ' o r r : i " r o m o L o G r . c r ' I : s . c o N T r t o 1 . u . . l , . I I l e H i l l l A r t r c ; A u g u s t 2 , 2 1 1 1 3 J I I 2 4 1 A u g u s t 1 1 , 2 1 1 1 . 1 ' H I E I ' E S T C O N T R O L 1 1 1 0 1 N A M I D I I L " V O W I I A S R E G I S 1 " 1 1 t h l 1 1 1 N 1 ) E R 1 1 1 E l ' I t O V I S I O N S 0 1 ' C l I A P I E R 0 1 2 1 ' O l t 1 . 1 1 1 : . P E R I O D 1 A P I R I N G : A u g u s t 3 1 , 2 1 1 1 4 A l 6 0 I I I N I S I P . 1 1 . I V N I ( 1 1 ' I I I L . I ' I 3 2 S 7 N c 4 ' " I a t 1 " A K i t s i ( ' ( r U T k r a l I N ! ��: 6 0 1 L I . N I S I I I I " L T q t ; N o e s a l I l e u s e l u t a P e e t ; n u ! I ( u t l e n t C o t t l e o f I . n t v I a n d O r n a u l e n l a l T e r m i t e a n t i O O i l % % ( / ( 1 C b u l r u l J A f \ I l i I ( I I V A , ( I I M M I C S I I I V 1 P e t > A _ 1 : L T A . 3 3 1 L t i ' L l l . i a i 7 _ 1 t n ; t i t " \ ' 4 1 / / c ��3 1 - r e L 1 1 , 3 . 1 v 1 M 1 / 7 2 T t i l l i A 1 1 , ' + 1 E L I 1 7 7 S ' n 0 . N . W i t i t r t 7 : i Cil� ofUrcktvio% P.O BOX 1209 CRESTVIEW, FL 32536 LOCATION: 1049 S WILSON ST BUSINESS CLASSIFICATION PEST CONTROL ISSUE BRYAN PEST CONTROL. INCORPORAT TO 911 DON DRIVE FORT WALTON BEACH FL 32547 II( It-000urur,Is LICENSE VALID THROUGH; September 30, 2015 LICENSE YEAR 2014 • 2015 DATE ISSUED July 30. 2014 LOCAL BUSINESS TAX RECEIPT CITY CLERK THIS MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS. PENALTY FOR FAILURE TO DO SO. SUBJECT TO FLORIDA STATUES FOR LOCAL BUSINESS TAX RECEIPTS City of Crestview P.O. BOX 1209 CRESTVIEW, FL 32536 LICENSE NO. 15-00000618 Ltu'A1toN t1L14S14it.SO`:st SUBJECT TO FLORIDA STATUES FOR LOCAL BUSINESS TAX RECEIPTS DATE July 30, 2014 LICENSE YEAR: 2014 - 2015 LICENSE VALID THROUGH September 30, 2015 BUSINESS CLASSIFICATION: PEST CONTROL ISSUE BRYAN PEST CONTROL, INCORPORAT TO 911 DON DRIVE FORT WALTON BEACH FL 32547 LOCAL BUSINESS TAX RECEIPT Elizabeth M. Roy CITY CLERK r THIS MUST BE POSTED_ CONSPICUOUSLY IN YOUR PLACE OF BUSINESS. PENALTY FOR FAILURE TO 00 SO. 08/19/2014 TUE 9128 x )P001/001 OP ID: AP ARE)• CERTIFICATE OF LIABILITY INSURANCE DATEIMM100lYYYY) 08I1912014 THIS CERTIFICATE 13 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NQT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING (NSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If tho certificate holder le an ADDITIONAL INSURED, the policylies) Inuit be endorsed, If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, Certain pollclee may require en a Idorsement. A statement on this certificate does not confer rights to tho cordllcato holder In lieu of each endo►aement{s). PRODUCER Ri mer Insurance Group Hallandale Branch PO Box 260 Hallandale, FL 33008.0250 Stephen L Rlemer CONTACT PHONE PA1( tics No, SWUVO, No: ADDRG98: CUSSTTOMER ID IP BRYAPEi INSURERS) AFFOROINO COVERAGE NAIC 0 INKIReo Bryan Peat Control, Inc. 388438 911 Don Drive Ft Walton Beach, FL 32547 mamma Insurance Co INSURER a :The Hartford INSURER e; INSURER 0 : INSURER E : INSURER F • COVERAGES CERTIFICATE NUMBER: REV THIS IS TO CERTIFY THAT THE POLICIES Of INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLLICYAIMS. ILTR TYPE OF INSURANCE JNIq y� POLICY NUMBER (MMIDOlYVYY) (MMDQYYYI LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY I CLAIMS MADE I X I OCCUR X LLS000002000 01/01/2014 01/01/2016 EACH OCCURRENCE S 1,000.000 PREM sEi?E 0Cc4Tt,,,o) 9 100,000 MED EXP (Any one pererd) 5 0 y 10,000 PERSONAL d ADV INJURY 1,000,000 �j CIF 11 AGGREGATE I. PAR APPLIES PER; POLICY I X _ PhRQ � we GENERAL AGGREGATE g 2,000,000 PRODUCTS • COMP/OP AGG •• S 2,000,000 4 AUTOMOBILE — - —• LIABILITY COMBINED 8INOLE LIMIT (Ea acoidenn BODILY INJURY (Per pariah) 8 $ BODILY IN,AJRY (Per accident) $ PROPERTY DAMAGE (PER ACCIDENT) $ C UJIeNELLA UAB X eIcs49 LIAR I OCCUR CumS-MADE CUA100089010 01/01/2014 01/01/2018 EACH OCCURRENCE 1: 1,0OD,000 AODREOATE S 1,000,000 D DEDUCTIBLE RETENTION $ $ $ wORKERS COMPENSATION ANO EMPLOYERS' LIABILITY Y r N ANY PROPRIETOR/PARTNER/EXECUTIVE MPod� In N j EXCLUDED? If yes, describe u^der DESCRIPTION OF OPERATIONS Bea.: N JA I WC STATU- OTH- 1 TORY LIMITS FR E L. EACH ACCIDENT $ E.L. DISEASE • EA EMPLOYEE 0 E L DISEASE - POLICY LIMIT S B Bond 21BODAH8498 08/28/2014 08/28/2016 Dishonest Bond 28,000 DESCRIPTION Or OPERATIONO r LOCATIONS r VEHICLES (Amon ACORD 101, Addlsonel Remsms Schedule If mere space Is required Pest Control Operations — City of Crestviewie included as an additional insured CERTIFICATE HO CANC Cityof Crestview CITYCR2 ew 198 N Wilson Street PO Box 1209 Crestview, FL 32536 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES DE! CANCELLED ReFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, - AUTNORIZED itereeSENTATTve �. 0)1080-2009 ACORD CORPORATION. All rlghte reserved. ACORD 28 12008l09) The ACORD (lame and logo are reglatered marks of ACORD BRYAPES-01 JBURCH ,d►coCERTIFICATE OF LIABILITY INSURANCE ��- DATE (MM/DD/YYYY) 8/26/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Acentria, Inc - Crestview 495 Ferdon Blvd South Crestview, FL 32536 CONTACT NAME: PHONE FAX (A/C, No, Ext): (A/C, No): E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Technology Insurance Company, Inc. 42376 INSURED Bryan Pest Control, Inc. 911 Don Drive Fort Walton Beach, FL 32547 INSURER B INSURER C : INSURER D : INSURER E INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLIC ES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL �D SUBR WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS -MADE OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PRO- JECT PER: LOC GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ $ AUTOMOBILE LIABILITY SCHEDULED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below / N N / A TWC3358141 05/28/2013 05/28/2014 X PER STATUTE OTH- ER E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYEE $ 500,000 E.L. DISEASE - POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is requi ed) CERTIFICATE HOLDER CANCELLATION City of Crestview Attn: Elizabeth Roy 198 Noth Wilson Street P.O. Drawer 1209 'Crestview, FL 32536 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE /1/7P- fiia4-e'"--- ACORD 25 (2014/01) ©1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Form W-9 (Rev. December2011) Department of the Treasury Internal Revenue Service Request for Taxpayer Identification Number and Certification Give Form to the requester. Do not send to the IRS. CVBusiness a> ca °- C ° N ao u °2 r H C a u F. U a in Name (as shown on your income tax return) Bryan Pest Control, Inc. name/disregarded entity name, if different from above Check appropriate box for federal tax classification: Trust/estate ► Individual/sole proprietor C Corporation NI S Corporation Partnership in company. Enter the tax classification (C=C corporation, S=S corporation, P=partnership) ► Exempt payee Limited liability iIl Other (see Instructions) Address (number, street, and apt. or suite no.) 911 Don Drive Requester's name and address (optional) City, state, and ZIP code Fort Walton Walton Beach, Florida 32547 List account number(s) here (optional) Part 1 Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box. The TIN provided must match the name given on the "Name" line to avoid backup withholding. For individuals, this is your social security number (SSN). However, for a resident alien, sole proprietor, or disregarded entity, see the Part I instructions on page 3. For other entities, it is your employer identification number (EIN). If you do not have a number, see How to get TIN on page 3. Note. If the account is in more than one name, see the chart on page 4 for guidelines on whose number to enter. Social security number Employer identification number 5 9 1 9 2 1 9 7 7 Part II Certification Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me), and 2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding, and 3. I am a U.S. citizen or other U.S. person (defined below). Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions on page 4. Sign Here Signature of U.S. person ► af& General Instructions Section references are to the Internal Revenue Code unless otherwise noted. Purpose of Form A person who is required to file an information return with the IRS must obtain your correct taxpayer identification number (TIN) to report, for example, income paid to you, real estate transactions, mortgage interest you paid, acquisition or abandonment of secured property, cancellation of debt, or contributions you made to an IRA. Use Form W-9 only if you are a U.S. person (including a resident alien), to provide your correct TIN to the person requesting it (the requester) and, when applicable, to: 1. Certify that the TIN you are giving is correct (or you are waiting for a number to be issued), 2. Certify that you are not subject to backup withholding, or 3. Claim exemption from backup withholding if you are a U.S. exempt payee. If applicable, you are also certifying that as a U.S. person, your allocable share of any partnership income from a U.S. trade or business is not subject to the withholding tax on foreign partners' share of effectively connected income. \rn(\Q-L) Date ► Note. If a requester gives you a form other than Form W-9 to request your TIN, you must use the requester's form if it is substantially similar to this Form W-9. Definition of a U.S. person. For federal tax purposes, you are considered a U.S. person if you are: • An individual who is a U.S. citizen or U.S. resident alien, • A partnership, corporation, company, or association created or organized in the United States or under the laws of the United States, • An estate (other than a foreign estate), or • A domestic trust (as defined in Regulations section 301.7701-7). Special rules for partnerships. Partnerships that conduct a trade or business in the United States are generally required to pay a withholding tax on any foreign partners' share of income from such business. Further, in certain cases where a Form W-9 has not been received, a partnership is required to presume that a partner is a foreign person, and pay the withholding tax. Therefore, if you are a U.S. person that is a partner in a partnership conducting a trade or business in the United States, provide Form W-9 to the partnership to establish your U.S. status and avoid withholding on your share of partnership income. Cat. No. 10231X Form W-9 (Rev. 12-2011) Steita PESTl NTROL 911 Don Drive Ft Walton Beach, FL 32547 850.862.3955 Fax 850.864.2815 604 Elm Street Niceville, FL 32578 850.678.5508 Fax 850.678.3890 1051 S. Wilson St Crestview, FL 32536 850.682.5553 Fax 850.689.0371 5454 Gulf Breeze Parkway Gulf Breeze, FL 32563 850.916.1124 Fax 850.916.1127 Destin, FL 850.837.5137 Pensacola, FL 850.969.9147 Complete Pest Management Services Premium Pest Control Total Tennite Protection Lawn & Ornamental Protection and Enhancement August 27, 2014 City of Crestview P.O. BOX 1209 Crestview, FL 32536 To Whom It May Concern; Let it be known to all concerned with the City of Crestview that Billy Riley, Branch Manager, Bryan Pest Control, Inc., has authority to sign documents as it relates to the pest control contract with the City of Crestview. Sincerely, Bryan O. Grimes President Bryan Pest Control 'Quality is our standard .. Excellence is our goal?" F}�A CO.Sentricon II Colony tlianlnalion Syn.= R.iwr PREMISE' nUnrl IIwIMATIO1 TERMIDOR ®topchoice tim art enrol www.bryanpestcontrol.com Roy, Elizabeth From: Jerry Miller [jerry@pleatperry.com] Sent: Wednesday, August 27, 2014 5:02 PM To: Roy, Elizabeth Subject: RE: pest control conract Contract approved as to form. Jerry Miller J. Jerome Miller, Esq. Pleat, Perry & Ritchie, PA 4477 Legendary Drive, Suite 202 Destin, Florida 32541 Telephone: 850.650.0599 j Fax: 850.650.4402 www.pleatperrv.com 1'I1'I:ItIL4' . VtI Ic:}1[t:, I'_:A. To follow us on FaceBook, go to www.facebook.com/pleatperrv. 1 To pay your invoice online via Credit Card or PayPal, visit our website www.pleatperrv.com. (Processing fees may apply.) Confidentiality Notice: This message, including any attachments, is intended only for the use of the individual or entity to which it is addressed and may contain information that is legally privileged and confidential. If you are not the intended recipient, you are hereby notified that any dissemination, distribution or copying of this communication is strictly prohibited. If you have received this message in error, please immediately contact the sender and delete or destroy the original message. Thank you for your cooperation in this regard. From: Roy, Elizabeth[mailto:elizabethroy(acityofcrestview.org] Sent: Wednesday, August 27, 2014 10:41 AM To: Jerry Miller Subject: pest control conract "Under Florida law, e-mail addresses are public records. If you do not want your e-mail address released in response to a public -records request, do not send electronic mail to this entity. Instead, contact this office by phone or in writing." 2